How ill is Yuvraj?

In sickness and in health, Yuvraj Singh, tends to leave the nation in a spin. In the best of times, he makes India win the Cricket World Cup. In the worst of times, he ties the nation up in knots of tension. A shock announcement on November 26, that he is battling a tumour in his left lung, has sent a wave of visceral anxiety through the cricket-crazy country.

In an official statement his mother, Shabnam Singh, said: "Reports showed that Yuvraj was dealing with something really serious. A golf ball-sized lump was found over his left lung and doctors advised us to go in for more detailed scans." But India's most flamboyant cricketer tweeted with characteristic nonchalance: "Nothing serious, need to build up the lost stamina."

The missing pieces of a puzzle have finally come together. Clearly, medical reasons explain why Yuvraj has been in and out of Team India post World Cup, why he skipped the West Indies tour in June-July citing lung infection and why his performance in England in the July-September Test series was below par. It's in the face of the rising tide of public criticism and ridicule that his mother decided to go public, "without his approval".

According to his mother, the initial reports suggested that Yuvraj had "an abnormal tumour called lymphoma" over his left lung that could be malignant. After a detailed scan and biopsy, however, the reports indicated that the tumour was non-malignant.

But that has put the medical fraternity in a quandary. According to Dr Harit Chaturvedi, chief consultant and director of surgical oncology at Max Hospital, Delhi, "Lymphomas are by definition malignant." They stand for cancer of the lymph nodes, found primarily in the neck, between the lungs and the heart, in abdomen, armpit or groin. "Lymphoma happens due to excessive growth of the lymph glands," explains Dr Raja Dhar, consultant respiratory physician, Fortis Hospital, Kolkata. Of the two types of lymphomas-the less virulent Hodgkins and more aggressive non-Hodgkins-and various sub-types, some tumours grow more slowly than others and may not need to be treated. Both Chaturvedi and Dhar point out that lymphomas, typically treated with chemotherapy, are potentially serious conditions.

"It's not a lymphoma," Shabnam says, when contacted by India Today. "It's a soft tissue growth between the heart and the lung that was initially considered malignant and life-threatening." It all started during the World Cup this year, when Yuvraj went through several spells of intense coughing and vomiting. He was in excruciating pain, restless and suffered from shortness of breath, too. "We thought it was due to allergies, stress and sleeplessness. It's not easy carrying the expectations of a billion people," she says.

Yuvraj has had to go through a battery of scans, tests and biopsies in the last few months. The third biopsy in October shows benign growth, Shabnam explains. "He must have been discovered with some shadow in the X-ray," says Dr Arvind Kumar, professor at the All India Institute of Medical Sciences. The first step starts with a chest X-ray. The next step is a CT scan, to detect the exact location and extent of tumours. The scans enable doctors to make a rough prediction of malignancy or benignity. "But that depends to a large extent on the age of the patient, symptoms and character of the shadow," he adds.

Youth is in Yuvraj's favour. In a 50-year-old smoker of 30 years, the first diagnosis of a shadow is taken as cancer. For a 29-year-old non-smoker like Yuvraj, the chances are slim. "His symptoms and history also tell the same story," says Dr Rakesh Jalali, professor of neuro-oncology at Tata Memorial Hospital in Mumbai. "He had been playing all along, despite the cough and other symptoms. I don't think he could keep doing that if it were a serious condition like lymphoma," he adds.

But why did Yuvraj need three biopsies? "Lung biopsy is a very tricky process," points out Kumar. Biopsy is the gold standard for deciding if a growth is cancerous or not. A piece of soft tissue is brought out from a growth and put under the microscope for final diagnosis. The most common method is the CT-guided biopsy, where a very thin needle is put in. "The 21 gauge needle that is normally used happens to be extremely thin. Often instead of tissue, just blood is drawn, necessitating repeat biopsies," says Kumar. If the tumour is too close to the windpipe, a special telescope with a camera has to be sent down the nose (bronchoscopy).

All the indicators point to a benign growth in Yuvraj's case. "It could be a sarcoidosis, tiny lumps of cells that grow and clump together due to lung infection," points out Chaturvedi. "Or even lung tuberculosis. Both can be treated by medicine." It could also be solitary pulmonary nodules, more than half of which are benign, caused mainly by old scars and infections. "There are a range of soft tissue growths that grow slowly in the lungs, do not have any symptoms and are cured completely if removed surgically," says Jalali.

Yuvraj couldn't believe it was happening to him initially, says his mother. But he refuses to give up. "His appetite is normal. He has home food, cooked in olive oil. He does his yoga, goes out to movies and tries to have as much fun as possible," she says. He still has his dream of becoming India's best Test cricketer to fulfil. And in moments of vulnerability, he has his gurujis, Sant Baba Ram Singhji and Ajit Singhji, to turn to. "I still have a lot of years to go, and I think these will be my best years." That's what he had told cricket website Cricinfo in June this year. His country looks forward to that future with him.